Spinal Cord Injury Model Systems Consumer Information
Employment after Spinal Cord Injury
Northwest Regional Spinal
Cord Injury System
Department of Rehabilitation
Medicine
University of Washington
Box 356490
Seattle, WA 98195
206-616-2183
[email protected]
http://sci.washington.edu/
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Most people with spinal cord injuries (SCI) want to work yet need support,
training and vocational rehabilitation services to help them obtain and keep
a job. These sources of support may help to overcome many barriers that
are outside the individual’s control, such as financial and health care issues,
accessibility, and employer attitudes.
Work is important to people not only because they can earn an income and
receive health insurance and other benefits, but also because it gives them
opportunities to interact with others and improved self-esteem and overall
life satisfaction. And although there is no cause-effect relationship, there are
consistent findings in the research that people who are employed after SCI
live longer and report higher satisfaction with life and better health than
people who are not working.
Although individuals with SCI can and do go on to have active work lives
and successful careers, they have more barriers to overcome than those
without disabilities. Federal and state laws and vocational rehabilitation services exist to help people with disabilities overcome these barriers.
The law protects you
Passed in 1990 and amended in 2008, the federal Americans with Disabilities
Act (ADA) prohibits employers from discriminating against qualified individuals with disabilities who are able to perform the essential functions of the
job with or without accommodation.
 To be protected under this law, you must have a disability that limits major
life activities. Nearly all people with SCI are protected under ADA.
 An employer must make “reasonable accommodation” to your disability if it
would not impose an undue hardship on the business. Whether an accommodation is considered a “hardship” depends on the business size, financial
resources, nature of operation and other factors.
 When you apply for a job, an employer cannot ask you about the existence,
nature or severity of your disability, even if you show up for your interview
in a wheelchair. An employer can ask you about your ability to perform
certain job functions.
 An employer can require you to pass a medical examination only if it is
job-related and required of all employees in similar jobs.
 If you feel an employer has discriminated against you, contact the U.S. Equal
Employment Opportunity Commission (EEOC). Call 800-669-4000 to find
the office nearest you, or go to www.eeoc.gov. Many states have powerful
disability rights laws as well.
Copyright © 2011 Model Systems Knowledge Translation Center (MSKTC).
Spinal Cord Injury Model Systems Consumer Information
The Individuals with Disabilities Education Act
(IDEA) is a law that helps young people who have
not yet finished their K-12 education receive the
services they need to meet their academic and
vocational goals and to ensure a smooth transition into adult life. Students eligible under this
law may remain in school until age 22 if the extra
time is necessary to achieve their goals. For more
information, contact the U.S. Department of
Education (800-872-5327) or visit the IDEA 2004
website at http://idea.ed.gov/.
What is vocational rehabilitation?
Vocational rehabilitation programs can help individuals with disabilities obtain employment. Through
these programs, a wide range of services are available to help people identify their career interests
and skills; acquire the relevant education or training;
find and apply for jobs; and get work accommodations. For people who are covered under worker’s
compensation (because they were injured on the
job), a similar set of vocational rehabilitation programs are often available.
Who pays?
 Some private health insurance companies
pay for vocational rehabilitation services. Check
with your insurer to find out what services are
covered.
 State vocational rehabilitation programs
are funded (through federal mandate) to provide
free vocational rehabilitation services for anyone
with a significant disability that limits their ability to work. Services include all the steps in the
vocational rehabilitation process described in
this factsheet.
 State workers’ compensation programs
provide free vocational rehabilitation services
for individuals who have been injured on the job.
 The Veterans Administration (VA) provides
vocational rehabilitation services to eligible beneficiaries with service related disabilities.
How does vocational rehabilitation
work?
Vocational rehabilitation can take place at any
time an individual with a disability needs help
finding or keeping employment. If you are not
Employment after Spinal Cord Injury
working but are interested in finding employment,
or if you are dissatisfied with your current job,
you might try vocational rehabilitation.
Whenever the process begins, it includes the following steps:
Getting started
Your rehabilitation medicine physician can refer
you to a vocational rehabilitation program, or you
can find these services yourself by visiting http://
askjan.org/cgi-win/TypeQuery.exe?902 for a listing of
the State Vocational Rehabilitation offices.
In many settings, vocational rehabilitation services
are provided by rehabilitation counselors with
master’s degrees who are specially trained to help
people with disabilities find and keep employment.
Assessment
Finding satisfying employment means matching
your interests and needs with the characteristics and demands of jobs. Being able to find and
maintain employment will also depend on your
abilities to meet the requirements of the jobs that
are available in the job market or your current job.
Your rehabilitation counselor will begin by helping
you to evaluate your interests, skills, limitations,
health needs, work and education histories, and
even personality style. The counselor gets this
information through interviews, questionnaires,
medical information from your physician, and
sometimes tests of academic aptitude and skills.
Your counselor may also set up real life opportunities for you to find out more about various jobs.
Real-life “tests”
Your rehabilitation counselor may be able to set
up a “trial” work situation for you with a potential
employer for a specified period of time to see if
you are able to do the job, if you like the job, and
what accommodations you might need. These
situations may be paid or unpaid. After the trial
period, both you and the employer can decide
whether it will be a good long-term fit.
The job market
Part of the process may be assessing the job
market related to various occupations.You may be
interested in a specific job in a particular industry,
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Spinal Cord Injury Model Systems Consumer Information
but if that industry is declining or does not have
opportunities in your geographic area, you might
need to look into something different.Your rehabilitation counselor can help you assess the job
opportunities in your area, as well as the wages,
tasks, education preparation and other characteristics of occupations you might be interested in.
Setting goals
The end-product of the rehabilitation counseling process is deciding on the specific career
or occupation you want to pursue. This is your
long-term goal. To get there, you may need to
complete several intermediate steps along the
way. These steps should be described in as much
detail as possible in a written plan that you and
your rehabilitation counselor create together.
For example, you may need to finish high school
or attend college to enter the occupation of your
choice, or perhaps you can go right to work. To
do either, you may need to increase your physical
endurance, find reliable accessible transportation
and accessible housing, and manage your medical needs so you can meet the demands of a job
schedule.
Landing a job
After thorough preparation and planning, people
with SCI often secure jobs on their own. Sometimes they need extra help, however. A rehabilitation counselor can help you determine
whether a potential job would be a good match
for you. He or she can conduct a job analysis to
determine the actual kinds of tasks done in that
particular job, the cognitive (thinking), social and
physical demands of the job, and the need for
accommodations. A job placement specialist can
help you identify specific opportunities in your
geographic area.
Discrimination in hiring is illegal even if it is not
intentional. Employers with no experience interacting with people who have disabilities may
assume someone with a disability cannot do the
work or hold down a job. In these cases, a rehabilitation counselor can step in and work with
the employer to overcome prejudices and suggest accommodations that improve the employer’s comfort in hiring a person with a disability.
Employment after Spinal Cord Injury
Getting support at work
You may need ongoing support and accommodations at work. Someone with high-level tetraplegia, for example, may need help with positioning
or personal care assistance during the work day.
These are typically not paid for by the employer,
and a source of funding for this assistance must
be identified in advance.
Types of accommodations
Job accommodations can include modifying
work schedules, tasks or the work environment.
Solutions can range from simple to high-tech.
Examples:
 Removing a desk drawer or raising the height of
a desk with four wood blocks so a wheelchair
can fit underneath.
 Special software and hardware so a person with
no hand function can work on a computer.
 A private changing area for someone who may
have occasional bladder accidents.
 Shifting work hours to a later start and end
to the work day to accommodate a worker’s
lengthy morning care needs.
 If a person has both SCI and a brain injury, he or
she may need additional support in the form of
extra supervision or job “coaching.”
A rehabilitation counselor can help determine
what kinds of accommodations might be helpful
and whether they constitute “undue hardship”
for the employer.
Work vs. benefits: finding a balance
Sometimes people are reluctant to start working because they don’t want to lose their medical
benefits under Social Security Disability Insurance (SSDI), Supplementary Security Income
(SSI), or private or state long-term disability
insurance (LTD). They may also be concerned
about the extra costs of getting to or staying at
work.
Federal work incentive programs under SSDI
or SSI allow people with disabilities to receive
benefits and federal health care (Medicare and/or
Medicaid) while still keeping some of their earnings from employment. This can be a powerful
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Spinal Cord Injury Model Systems Consumer Information
incentive for someone with a high-level SCI who
has a strong desire to work but needs personal
care assistance on the job, must pay for a van, and
needs other services in order to work. Some
LTD policies include vocational rehabilitation
benefits or incentives to return to work.
Work-incentive programs are complicated. and
you may want to consult your vocational rehabilitation counselor, a resource specialist with
an independent living center, or a social worker
familiar with benefits systems. (Also see “Resources,” below.)
If employment is not possible
Sometimes it is not possible for a person to
obtain any kind of work after SCI. This includes
people who cannot earn enough by working to
pay for their own personal care assistance and
other disability costs. People who live in rural
areas may not have access to transportation or
employment. Older workers may not be able to
transfer their pre-injury skills to a new occupation. In these cases, the individual can apply for
disability benefits with the help of the rehabilitation counselor or other health provider.
A person is eligible to receive disability payments
from the Social Security Administration (SSA) if
he or she is unable to perform any kind of work
at a level of “substantial and gainful” activity and
the disability is expected to last at least a year.
The SSA pays disability benefits under two programs:
 Social Security Disability Insurance (SSDI)
is a long-term disability insurance program
funded by payroll taxes. Eligibility is based on
your past work history and income.
 Supplemental Security Income (SSI) is a
federal welfare program for people with disabilities
who are unable to work and are low income.
Newly injured individuals with SCI should
apply for SSA benefits immediately if it
seems likely that they will not return to
work for at least a year. Sometimes there is a
waiting period before starting to receive benefits.
Once enrolled, a person is immediately eligible
for either state Medicaid benefits or, after a waiting period, for federal Medicare benefits.
Employment after Spinal Cord Injury
The case for volunteering
If paid employment is not possible, consider getting involved in a volunteer activity. Not only can
volunteering provide enjoyment and a sense of
accomplishment, it can give you the skills, confidence and professional contacts that might eventually lead to paid employment some day.
Reference
Johnson, K. (2009).Vocational Rehabilitation (pp.
715–722). In V. Lin (Ed.), Spinal cord medicine: Principles and Practice. New York: Demos.
Resources
 Benefits for People with Disabilities, Social Security Administration: http://www.ssa.gov/disability/
 Find your local Vocational Rehabilitation Agency,
Job Accommodation Network, U.S. Department of
Labor: http://askjan.org/cgi-win/TypeQuery.exe?902
 The Red Book: A Guide to Work Incentives,
Social Security Administration:
http://www.socialsecurity.gov/redbook/
 Social Security Area Work Incentive Coordinators
(AWIC) provide information about work incentive
programs.You can find the AWIC in your area at
http://www.ssa.gov/work//awiccontacts.html.
Source
Our health information content is based on
research evidence whenever available and represents the consensus of expert opinion of the SCI
Model System directors and staff.
Authorship
Employment after Spinal Cord Injury was developed
by Kurt Johnson, PhD and Jim Krause, PhD, in
collaboration with the Model Systems Knowledge Translation Center.
Disclaimer
This information is not meant to replace the
advice from a medical professional.You should
consult your health care provider regarding specific medical concerns or treatment.
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